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Psychological and Emotional Effects of the September 11 Attacks on
the World Trade Center --- Connecticut, New Jersey, and New York, 2001

To measure the psychological and emotional effects of the September 11, 2001, terrorist attacks on the World Trade
Center (WTC), Connecticut, New Jersey, and New York added a terrorism module to their ongoing Behavioral Risk
Factor Surveillance System (BRFSS). This report summarizes the results of the survey, which suggest widespread psychological
and emotional effects in all segments of the three states' populations. The findings underscore the importance of
collaboration among public health professionals to address the physical and emotional needs of persons affected by the September
11 attacks.

BRFSS is a random-digit--dialed telephone survey of the noninstitutionalized U.S. population aged
>18 years (1,2). The terrorism module consisted of 17 questions which asked respondents whether they were victims of the terrorist
attacks, attended a memorial or funeral service after the attacks, were employed or missed work after the attacks, increased
their consumption of tobacco and/or alcohol following the attacks, or watched more media coverage following the attacks.
The survey was conducted during October 11--December 31. A total of 3,512 respondents completed the module in the
three states (1,774 in Connecticut, 638 in New Jersey, and 1,100 in New York). SAS and SUDAAN were used in the analyses
to account for the complex sampling design.

Of the 3,512 participants, approximately 50% participated in religious or community memorial services, and 13%
attended a funeral or a memorial service for an acquaintance, relative, or community member (Table). Three fourths (75%)
of respondents reported having problems attributed to the attacks. Nearly half (48%) of respondents reported that
they experienced anger after the attacks. Approximately 12% of respondents with problems reported getting help. Family
members (36%) and friends or neighbors (31%) were the main source for help. Approximately 3% of alcohol drinkers
reported increased alcohol consumption, 21% of smokers reported an increase in smoking, and 1% of nonsmokers reported that
they started to smoke after the attacks.

The impact of the attacks varied by sex, age group, educational level, and race/ethnicity. Compared with men, women
were more likely to have participated in a religious or community memorial service (55.1% [95% confidence interval
(CI)=54.2%--55.9%] versus 43.0% [95% CI=41.7%--44.3%]) and to get help with the problems they experienced (15.3%
[95% CI=13.0%--17.6%] versus 8.8% [95% CI=7.9%--9.6%]). Men were more likely than women to drink more alcohol
(4.2% [95% CI=3.4%--4.9%] versus 2.4% [95% CI=2.1%--2.6%]), and women smokers were more likely than men to smoke
more as a result of the attacks (27.1% [95% CI=23.9%--30.3%] versus 14.8% [95%
CI=12.3%--17.3%]).

Approximately 27% of respondents who were working at the time of the attacks missed work afterwards. The major
reason for missing work was transportation problem (51%). Approximately 21% of workers had to be evacuated on the day of
the attacks. Approximately 80% of respondents reported watching more media coverage than usual on television or through
the Internet. Approximately 3% of respondents reported that they were victims of the attacks, 7% had relatives who were
victims, and 14% had friends who were victims. In Connecticut, New Jersey, and New York, 4%, 17%, and 35% of the
respondents, respectively, reported being in New York City during the attacks.

Editorial Note:

The findings in this report document the widespread emotional and psychological effects among residents
of three states following the September 11 attacks and indicate that some persons sought help to cope with the
catastrophic events. Although this survey inquired about the short-term effects of the attacks, the findings suggest the need to consider
the long-term emotional and psychological health of the affected population. The flexible design of BRFSS allows states to
add questions to their ongoing surveys to address changing situations and crises, such as the WTC attacks.

The findings in this report are subject to at least four limitations. First, the survey design excluded persons without
a telephone, which primarily includes persons of low socioeconomic status. Second, the survey excluded persons who were
not yet able to discuss their emotional response to the attacks. Third, the survey did not measure the severity and duration
of emotional and psychological problems of the respondents. Finally, the survey might have excluded persons who had
moved from the area after the attacks.

Public health professionals should consider the emotional and psychological well-being of persons after traumatic
events. The results of community-based surveys can help target programs designed to help residents deal with the aftermath
of terrorist attacks. In response to national disasters, several programs have been implemented successfully to provide
immediate medical care and to prevent the spread of infections and disease; however, the long-term emotional pain and
suffering associated with disasters also needs to be considered in response planning. State and federal agencies should prepare
programs to address the emotional and psychological health of persons, and these programs should be integrated with other
disaster-preparedness plans.

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